Sinha Rajni, Lonial Sagar
Winship Cancer Institute, Emory University, 1365 Clifton Road, Building C, Room 4004, Atlanta, GA 30322, USA.
Curr Treat Options Oncol. 2006 May;7(3):246-57. doi: 10.1007/s11864-006-0017-6.
Treatment options for patients with relapsed myeloma are a rapidly moving entity. Although autologous transplantation has improved outcomes for younger patients, the use of a second autologous transplant in the relapsed setting has less benefit. Nonmyeloablative allogeneic transplant is being studied in several large cooperative group trials, but to date early auto/mini-allo does not appear to be superior to tandem autologous transplantation. The greatest benefit in the relapsed setting has been demonstrated using novel targeted agents with biologically based therapies. The response rates from thalidomide with and without dexamethasone, bortezomib, and lenalidomide with and without dexamethasone clearly demonstrate high levels of activity with encouraging durations of remission. More recent studies are combining novel agents, and small phase I/II trials are demonstrating higher overall response and complete remission rates. The next generation of novel agents targeting heat shock proteins, the mitogen-activated protein kinase pathway, and monoclonal antibodies are further expanding the list of future potential agents. The rapid clinical development of targeting agents will give us more options to treat patients with relapsed or refractory myeloma, thereby improving quality of life and overall survival.
复发骨髓瘤患者的治疗选择是一个快速发展的领域。虽然自体移植改善了年轻患者的治疗效果，但在复发情况下进行第二次自体移植的获益较少。非清髓性异基因移植正在多个大型协作组试验中进行研究，但迄今为止，早期自体/微型异基因移植似乎并不优于串联自体移植。在复发情况下，使用新型靶向药物联合基于生物学的疗法已显示出最大的获益。沙利度胺联合或不联合地塞米松、硼替佐米以及来那度胺联合或不联合地塞米松的缓解率清楚地表明这些药物具有高活性，缓解期令人鼓舞。最近的研究正在将新型药物联合使用，小型I/II期试验显示出更高的总缓解率和完全缓解率。靶向热休克蛋白、丝裂原活化蛋白激酶途径的下一代新型药物以及单克隆抗体正在进一步扩充未来潜在药物的名单。靶向药物的快速临床进展将为我们提供更多治疗复发或难治性骨髓瘤患者的选择，从而改善生活质量和总生存期。
